Document Type : Original Article



BACKGROUND: Depression is a disorder of the brain, a state of low mood and aversion to activity
that can affect a person’s thoughts, behavior, feelings, and sense of well‑being and can cause
alteration in sympathetic activity of the body, thus affecting heart rate variability (HRV).
AIM: The study was conducted to determine the effects of depression on HRV parameters in clinically
known cases of depression.
MATERIALS AND METHODS: A cross‑sectional (observational) study was conducted on fifty known
patients of depression, aged 18–65 years, and fifty healthy, age‑matched, normal controls. HRV test
was conducted, and the results were analyzed statistically using Student’s “t”‑test for equal variance,
for various parameters.
RESULTS: The study showed that the differences in mean R‑R interval(s), mean HR (beats/min),
very low frequency (VLF) power (milliseconds squared [ms2
]), and low frequency/high frequency
(LF/HF) power (%) (LF/HF ratio) among controls and cases were statistically highly significant, while
the differences in LF power (ms2
) in controls and cases were statistically significant. However, the
differences in basic anthropometric parameters, STD (standard deviation of the normal to normal)(s),
root mean square successive difference (ms), NN50 (count), pNN50 (%), VLF peak (Hz), LF peak (Hz),
HF peak (Hz), HF power (ms2
), VLF power (%), LF power (%), HF power (%), LF power (nu), and
HF power (nu) were found to be statistically insignificant.
CONCLUSION: Depression leads to changes in autonomic control of the body and changes the
autonomic balance in favor of an increased sympathetic tone, which can be detected with fair
accuracy with HRV analysis.


  1. The National Institute of Mental Health: Available from: https://
    [Last accessed on 2018 Feb 25].
    2. National Institutes of Health / U.S. National Library of Medicine.
    Available from: [Last
    accessed on 2018 Jan 11].
    3. Chalmers JA, Quintana DS, Abbott MJ, Kemp AH. Anxiety
    disorders are associated with reduced heart rate variability:
    A meta‑analysis. Front Psychiatry 2014;5:80.
    4. Koskie B. Depression: Facts, Statistics and You; 2018. Available
    facts‑statistics‑ infographic#1. [Last accessed on 2019 Jul 25].
    5. Carney RM, Freedland KE, Stein PK, Skala JA, Hoffman P,
    Jaffe AS. Change in heart rate and heart rate variability during
    treatment for depression in patients with coronary heart disease.
    Psychosom Med 2000;62:639‑47.
    6. Sathish B, Bhat R, Damodara M. Autonomic modulation in
    different phases of menstrual cycle in young and older Indian
    women. Int J Med Res 2013;1:12‑6.
    7. Lee CL, Chang WD. The effect of cigarette smoking on aerobic
    and anaerobic capacity and heart rate variability among female
    university students. Int J Womens Health 2013;5:667‑79.
    8. Tarvainen MP, Kubois NJ. HRV Users Guide. Ver. 2.1. Biosignal
    Analysis and Medical Imaging Group (BSAMIG), Department
    of Applied Physics, University of Eastern Finland, Kuopio,
    FINLAND. MATLAB. Copyright 1984‑2012 The MathWorks, Inc.
    MATLAB is a registered trademark of The MathWorks, Inc. 2012.
    p. 8‑12.
    9. Gritti I, Defendi S, Mauri C, Banfi G, Duca P, Roi GS. Heart rate
    variability, standard of measurement, physiological interpretation
    and clinical use in mountain marathon runners during sleep and
    after acclimatization at 3480 m. J Behav Brain Sci 2013;3:26‑48.
    10. Doss SS, Anandhalakshmi S, Rekha K, Akhil AK. Effect of
    Smoking on heart rate variability in normal healthy volunteers.
    Asian J Pharm Clin Res 2016;9:230‑34.
  2. 11. Kaya H, Suner A, Koroglu S, Akcay A, Turkbeyler IH and
    Koleoglu M. Heart rate variability in familial Mediterranean fever
    patients. Europ J Rheumatol 2014;1:58‑61.
    12. Karim N, Hasan JA, Syed SA. Heart rate variability – A review.
    J Basic Appl Sci 2011;7:71‑7.
    13. (Authors not listed) Heart rate variability: Standards of
    measurement, physiological interpretation, and clinical use.
    Task force of the European Society of Cardiology and the North
    American Society of Pacing and Electrophysiology. Eur Heart J
    14. Sayar K, Güleç H, Gökçe M, Ismail AK. Heart rate variability in
    depressed patients. Bull Clin Psychopharmacol 2002;12:130‑33.
    15. Licht CM, de Geus EJ, Zitman FG, Hoogendijk WJ, van Dyck R,
    Penninx BW. Association between major depressive disorder and
    heart rate variability in the Netherlands study of depression and
    anxiety (NSEDA). Arch Gen Psychiatry 2008;65:1358‑67.
    16. Janca A, Hiller W. ICD‑10 checklist – A tool for clinicians use
    of the ICD‑10 classification of mental and behavioral disorder.
    Compr Psychiatry 1996;37:180‑7.
    17. BMI Classification, Global Database on Body Mass Index. World
    Health Organization; 2006.
    18. Du Bois D, Du Bois EF. A formula to estimate the approximate
    surface area if height and weight be known. Arch Intern Med.
    19. Agelink MW , Boz C, Ullrich H, Andrich J. Relationship between
    major depression and heart rate variability. Clinical consequences
    and implications for antidepressive treatment. Psychiatry Res
    20. Davidson J, Watkins L, Owens M, Krulewicz S, Connor K,
    Carpenter D, et al. Effects of paroxetine and venlafaxine XR on
    heart rate variability in depression. J Clin Psychopharmacol
    21. Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF.
    Depression, comorbid anxiety disorders, and heart rate variability
    in physically healthy, unmedicated patients: Implications for
    cardiovascular risk. PLoS One 2012;7:e30777.
    22. Brunoni AR, Kemp AH, Dantas EM, Goulart AC, Nunes MA,
    Boggio PS, et al. Heart rate variability is a trait marker of
    major depressive disorder: Evidence from the sertraline vs.
    electric current therapy to treat depression clinical study. Int J
    Neuropsychopharmacol 2013;16:1937‑49.
    23. O’Regan C, Kenny RA, Cronin H, Finucane C, Kearney PM.
    Antidepressants strongly influence the relationship between
    depression and heart rate variability: Findings from the
    Irish longitudinal study on ageing (TILDA). Psychol Med
    24. Sgoifo A, Carnevali L, Alfonso Mde L, Amore M. Autonomic
    dysfunction and heart rate variability in depression. Stress
    25. Paniccia M, Paniccia D, Thomas S, Taha T, Reed N. Clinical
    and non‑clinical depression and anxiety in young people:
    A scoping review on heart rate variability. Auton Neurosci
    26. Chen X, Yang R, Kuang D, Zhang L, Lv R, Huang X, et al. Heart
    rate variability in patients with major depression disorder during
    a clinical autonomic test. Psychiatry Res 2017;256:207‑11.
    27. Gehi A, Mangano D, Pipkin S, Browner W, Whooley M.
    Depression and heart rate variability in patients with stable
    coronary heart disease. Arch Gen Psychiatry 2005;62:661‑6.
    28. Carney RM, Blumenthal JA, Stein PK, Watkins L, Catellier D,
    Berkman LF, et al. Depression, heart rate variability, and acute
    myocardial infarction. Circulation 2001;104:2024‑8.
    29. Ha JH, Park S, Yoon D, Kim B. Short‑term heart rate variability
    in older patients with newly diagnosed depression. Psychiatry
    Res 2015;226:484‑8.
    30. Wang Y, Zhao X, O’Neil A, Turner A, Liu X, Berk M. Altered
    cardiac autonomic nervous function in depression. BMC
    Psychiatry 2013;13:187.
    31. Royster EB, Trimble LM, Cotsonis G, Schmotzer B, Manatunga A,
    Rushing NN, et al. Changes in heart rate variability of depressed
    patients after electroconvulsive therapy. Cardiovasc Psychiatry
    Neurol 2012;2012:794043.
    32. Askelrod S, Gordon D, Ubel FA, Shannon DC, Berger AC,
    Cohen RJ. Power spectrum analysis of heart rate fluctuation:
    A quantitative probe of beat‑to‑beat cardiovascular control.
    Science 1981;213:220‑2.